Patella Biopoly plug versus patellafemoral arthroplasty - sport?

[Mabs]

Hi All,

I've posted on here before about damaging the back of my patella with an impact injury early in 2016. I've final been offered knee replacement surgery, which I'm glad about as the pain is really affecting my quality of life (can't drive far, struggle with trips away etc.)

Plan 1: Go in a do a biopoly plug of the 1 x 1.5 cm hole in the articular surface in back of knee cap, or
Plan 2: if the damage is looking too bad in femoral grove, go for an patellafemoral arthroplasty.

won't know until surgery day.

I'd be grateful for anyone's stories on getting back to sport following this. I'm 37, was previously super active (football, cycling, climbing, running, squash etc.... you name it!). I realise I'm not going to be like this anymore, but after the last couple of years I'd be happy just to be out doing something at the weekends. Cycling was a newer hobby and I loved it but I think because of the exact point where the damage (mid to top area of medial surface) is on my knee cap it currently causes swelling with 20 mins on an exercise bike.

I have been super conscientious with physio, and following an arthroscopy in Dec 2016 I have managed to build up the lost muscle fairly well with low rep weight stuff, and generally got a lot of my flexibility back.

Op will be in a few months. Just trying to manage my expectations and try and have something to look forward to. I'm happy not to really run or play football anymore - just want to be active in some way. I live in yorkshire, missing the dales!

I'd be particularly interested in anyone whos has a biopoly plug - seems like a really new technique in the UK.

Cheers. M.

[RGB]

Hi Mabs. The following two threads may be of interest:

1. The latest page of http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55386.615 and
2. http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=74611.0

They contain pretty much all I've got to say on the subject of patellofemoral arthritis and PFJRs in particular but if you have any specific questions then feel free to ask. Dave33 also has a lot of relevant experience (although not PFJR yet) so would be worth taking notice of.

Latest update - my knee did not much appreciate my two days of skiing at just over 1 year post-op. The actual skiing was fine - the aftereffects not so much. Swelling and a low tolerance to walking/standing. It's coming right now after 10 days but something I'll be cautious about repeating. In my case it's hard to tell if it is the PFJR causing issues or the missing part of the medial meniscus.

[Mabs]

Hi RGB,

I had seen the first thread you just posted but couldn’t work out what you had done in the first place, accident wise? Thanks so much for replying.

It’s given me a lot of hope.  Can I ask what ‘state’ you were in before the op aside from meniscus tear?

I’m currently being told rest of knee is perfect in terms of the MRI, but I am getting patella tendon or fat pad pain. Most likely as a result of knee being swollen a lot of the time but hoping that it’s  not the cause rather than secondary consequence. I apparently have no other arthritic signs on mri. I should also say I’m female and only 100 pounds so hoping that helps matters. Physio is saying I’m doing remarkably well at keeping muscle tone considering, I’ve mastered 2/3 very short physio  sessions per day and icing to keep going, hoping there is an end in sight.   

Sorry to hear about the sking causing swelling.  Hope you’re not too disappointed by it. 

[RGB]

Hi Mabs. The original injury was a ruptured ACL more than 25 years ago. I had repair done using the patella tendon which was fine in itself but probably resulted in some patella misalignment and cartilage wear. I thrashed the knee afterwards with all manner of physical activities so it owes me nothing. However, about 7/8 years ago, I started getting pain with skiing, hill running and some sport climbing moves. An arthroscopy resulted in a partial meniscus removal and microfracture to the trochlea groove. It was all downhill from there: more arthroscopies, injections, more pain, less function until the PFJR. Just pre-op, I had full thickness lesions on the patella and in the centre of the groove. I could walk on the flat but not a lot else - cycling, more than one flight of stairs etc all brought swelling and pain. As I think I said in a previous post, the knee always felt fine on the day if I pushed it - the payback was a couple of days later.

I'm about to lecture you now so ignore if this is inappropriate:
1. Keep up the physio - it's probably a lifelong discipline now. However, make sure it's not causing more pain/swelling. Unless your physio is very good, he or she will be tempted to give you exercises which strengthen the muscles but also cause more damage.
2. Think hard before surgery. I'm no medical expert and your problems are likely different to mine. But the fact is that there was no good solution to my problems: surgical or otherwise. I sometimes wish I hadn't started on that slippery slope of trying to find one. I'm definitely much better now than I was pre-PFJR. But better than if I'd never had that first microfracture? I can't say.

End of lecture. Always happy to help.

[Mabs]

Hi,

No worries about the lecture! Physio is telling me to avoid the stuff that makes it swell, they have been good throughout but just think it's beyond conservative treatment. Last consultant I saw told me to totally stop all knee bending exercises and pain is more manageable now but I literally can't drive more than 20mins without pain at the moment, and stuff like that triggers swelling. I'm getting by by keeping my leg straight as much as I can, all the time!  Really think there is no other option for me now.  Had no issues at all before the accident, just literally knocked a huge chunk out of the back of my kneecap with one fall. Crappy luck.

Be a few months for me but I'll update this post for others and it would be good to hear how Dave33 gets on.


Cheers!

[Dave33]

I'd be particularly interested in anyone whos has a biopoly plug - seems like a really new technique in the UK.
Cheers. M.

Heh, I almost wish you hadn't posted.. I researched the biopoly plug, and it seems like a great idea, which would likely suit my situation better than the PJFR that's planned next month, since it's only my patella, not my trochlea, that has damage.

That said, I'd have a lot of questions about the science  - ie - the hyalgan that's embedded in the polymer "permanent"? Or does it wear away like a popsicle and lead to resistance/friction? I'd also be concerned about proper implant height around the surrounding cartilage.. the OATS transplants in the cartilage caused a lot of issues with catching in patella use. I'd also be concerned with how the native trochlea truly interacts./wears with a synthetic device. Does this device burn any bridges? Could one convert to a full pjfr with no ill effects? -  and ulimately, I'd be concerned with a lack of longer term wear/satisfaction studies...  Ultimately though, this looks like a synthetic version of an OATS plug, which would be really neat if it actually meets expectation.

Big decision, for sure!

cheers

[Mabs]

Hi Dave33,

sorry for not replying, been away.

the only question I can answer is that apparently they shave it down to just below the surrounding cartilage surface. So it should sit to fit.

My consultant said polyplug is preferable, but yeah, if I have too much damage in trochlea groove they will do a full PJFR so I'm guessing that poly plugs only work if you really have nothing else going on. He didn't mention it burning bridges in my consultation.

Let me know how things go on with yours. Good luck.

M.

[Dave33]

Hi Dave33,

sorry for not replying, been away.

the only question I can answer is that apparently they shave it down to just below the surrounding cartilage surface. So it should sit to fit.

My consultant said polyplug is preferable, but yeah, if I have too much damage in trochlea groove they will do a full PJFR so I'm guessing that poly plugs only work if you really have nothing else going on. He didn't mention it burning bridges in my consultation.

Let me know how things go on with yours. Good luck.

M.

No problem! It sounds similar to a product that arthrosurface (I think) used to make.. essentially looked like a screwhead, and simply was implanted in the bone on the area of loss. Do you have a surgery date booked?

Unfortunately, mine got delayed. I was supposed to go next week, but it's been pushed to October. So much for recovering in the nice weather.

[Mabs]

Sorry to hear surgery was postponed.

No date yet but it's supposed to be 18 weeks from referral (so end of October!). Not being able to bend my leg much is a bit pants so fingers crossed I'm not delayed even more.

Good luck! (and what good weather?!).

M.